ABSTRACT
Changes in motor activity are common in individuals with Frontotemporal dementia (FTD). Yet, it remains unclear why some individuals become motorically hyperactive, while others hypoactive even in early stages of the disease. This study aimed to examine the relationship between motor activity level and (1) FTD clinical subtype, and (2) cortical thickness and subcortical volumes. Eighty-two charts were retrospectively reviewed from patients meeting consensus criteria for one of the three main clinical subtypes of FTD: probable bvFTD, semantic variant Primary Progressive Aphasia (PPA), or non-fluent variant PPA. Participants were assigned to one of three groups: (1) hyperactive, (2) hypoactive, or (3) no record of change. Hyperactivity was prevalent among bvFTD (58.5%) and semantic PPA (68.8%) subtypes while hypoactivity was less common in both subtypes (29.3% and 18.8%, respectively). The majority of patients with non-fluent PPA showed no record of change in motor activity (66.7%). The analysis of cortical thickness and subcortical volumes did not identify significant associations with motor activity levels. In conclusion, increased motor activity is highly prevalent among individuals with FTD, especially bvFTD and svPPA subtypes. These findings may inform prognosis and prediction of changes in motor activity, and allow planning for appropriate environmental and behavioural interventions. Future studies with prospective, standardized longitudinal collection of information regarding the type and level of change in motor activity, including wearable measures of actigraphy, may help to further delineate the onset and progression of abnormal motor behaviours and determine neuroanatomic associations in FTD.
Subject(s)
Frontotemporal Dementia , Humans , Frontotemporal Dementia/diagnostic imaging , Retrospective Studies , Motor ActivityABSTRACT
INTRODUCTION: Depression and epilepsy are highly prevalent diseases and represent a worldwide public health problem. DEVELOPMENT: A non-systematic search was performed in PubMed (MEDLINE) considering current topics in pathophysiological, clinical concepts and treatment strategies in people with epilepsy and depression. RESULTS AND CONCLUSIONS: Depression and epilepsy have a bidirectional relationship and share some pathophysiological substrates. Depression is the most common neuropsychiatric manifestation in epilepsy; screening and diagnosis are important to start a timely treatment. Antidepressant drugs does not increase the frequency of seizures, on the contrary, it is believed that antidepressants may help reducing the frequency of seizures. In addition, other antidepressant therapies such as Cognitive Behavioral Therapy and neuromodulation may be also effective for reducing the frequency of seizures. However the evidence regarding antidepressant treatment(s) in epilepsy is limited and further prospective studies are needed to better characterize the possible therapeutic strategies and develop standarized treatment guidelines.
TITLE: Depresión en pacientes con epilepsia. Conceptos fisiopatológicos, clínicos y estrategias terapéuticas.Introducción. La depresión y la epilepsia son entidades altamente prevalentes y representan un problema de salud pública a nivel mundial. Desarrollo. Realizamos una búsqueda no sistemática en PubMed (MEDLINE) acerca de los conceptos fisiopatológicos y clínicos y las estrategias terapéuticas en pacientes con epilepsia y depresión. Resultados y conclusiones. La depresión y la epilepsia tienen una relación bidireccional y comparten algunos sustratos fisiopatológicos. La depresión es la manifestación neuropsiquiátrica más frecuente en la epilepsia; es importante el cribado y el diagnóstico para el manejo oportuno. El tratamiento con la mayoría de los medicamentos antidepresivos no incrementa la frecuencia de crisis, al contrario, se cree que puede incluso ayudar a disminuir el número de crisis de epilepsia. Además, existen otras terapias antidepresivas, como la terapia cognitivo-conductual y terapias con neuromodulación, que también llegan a ser eficaces en la reducción de la frecuencia de las crisis de epilepsia. Sin embargo, la evidencia respecto al tratamiento es limitada y se requiere un mayor número de estudios prospectivos para la caracterización de las estrategias terapéuticas y la creación de guías estandarizadas.
Subject(s)
Depression , Epilepsy , Humans , Depression/etiology , Depression/therapy , Epilepsy/therapy , Epilepsy/drug therapy , Seizures/drug therapy , Antidepressive Agents/therapeutic use , PsychotherapyABSTRACT
Introducción: La depresión y la epilepsia son entidades altamente prevalentes y representan un problema de salud pública a nivel mundial. Desarrollo: Realizamos una búsqueda no sistemática en PubMed (MEDLINE) acerca de los conceptos fisiopatológicos y clínicos y las estrategias terapéuticas en pacientes con epilepsia y depresión. Resultados y conclusiones. La depresión y la epilepsia tienen una relación bidireccional y comparten algunos sustratos fisiopatológicos. La depresión es la manifestación neuropsiquiátrica más frecuente en la epilepsia; es importante el cribado y el diagnóstico para el manejo oportuno. El tratamiento con la mayoría de los medicamentos antidepresivos no incrementa la frecuencia de crisis, al contrario, se cree que puede incluso ayudar a disminuir el número de crisis de epilepsia. Además, existen otras terapias antidepresivas, como la terapia cognitivo-conductual y terapias con neuromodulación, que también llegan a ser eficaces en la reducción de la frecuencia de las crisis de epilepsia. Sin embargo, la evidencia respecto al tratamiento es limitada y se requiere un mayor número de estudios prospectivos para la caracterización de las estrategias terapéuticas y la creación de guías estandarizadas.(AU)
Introduction. Depression and epilepsy are highly prevalent diseases and represent a worldwide public health problem. Development: A non-systematic search was performed in PubMed (MEDLINE) considering current topics in pathophysiological, clinical concepts and treatment strategies in people with epilepsy and depression. Results and conclusions: Depression and epilepsy have a bidirectional relationship and share some pathophysiological substrates. Depression is the most common neuropsychiatric manifestation in epilepsy; screening and diagnosis are important to start a timely treatment. Antidepressant drugs does not increase the frequency of seizures, on the contrary, it is believed that antidepressants may help reducing the frequency of seizures. In addition, other antidepressant therapies such as Cognitive Behavioral Therapy and neuromodulation may be also effective for reducing the frequency of seizures. However the evidence regarding antidepressant treatment(s) in epilepsy is limited and further prospective studies are needed to better characterize the possible therapeutic strategies and develop standarized treatment guidelines.(AU)
Subject(s)
Humans , Depression , Epilepsy , Comorbidity , Neuropsychiatry , Therapeutics , Antidepressive Agents , Neurology , Nervous System DiseasesABSTRACT
OBJECTIVES: 1) to evaluate the possibility of distinguishing pleural transudates and exudates through the joint determination of 26 biochemical parameters in pleural effusion and in plasma (including the determination of high molecular weight proteins, acute phase reactants, and proinflammatory citokines), and 2) to formulate a logistic regression equation for optimizing the classification efficiency, comparing the equation obtained with Light's criteria. PATIENTS AND METHODS: All diagnostic thoracocentesis carried out in La Rioja Autonomous Community during a 22-month period were evaluated. The 245 clinical records were evaluated periodically along a minimum of 2 years, after the discharge of the patients. In pleural effusion and in plasma the following were quantified: total proteins, LDH, glucose, amylase, cholesterol, albumin, cholinesterase, phosphatase alkaline, urea, beta2-microglobulin, IgG, IgM, alpha2-macroglobulin, C reactive protein, transferrin, alpha1-antitrypsin, serum amyloid A protein, interleukin 1-beta, interleukin 6, tumoral necrosis factor-alpha, and lysozyme. In addition, the cellularity, polymorphonuclear elastase and adenosine deaminase were evaluated in pleural fluid. RESULTS: The LDH pleural effusion/plasma ratio was the individual parameter that showed higher area under the receiver operating characteristic curve for the separation of pleural transudates and exudates. Interleukin 6 and tumoral necrosis factor-alpha showed pleural effusion/plasma ratios higher than the unit, which suggests an in situ citokines production. An predictive logistic regression equation was obtained that incorporates only LDH and cholesterol ratios, including the diuretic treatment of the patient at the time of thoracocentesis, which did not modify the protein concentrations in pleural effusion. Except for LDH ratio, the logistic regression equation showed an area under the receiver operating characteristic curve higher than that of all the evaluated individual parameters, with a sensitivity of 95% and a specificity of 85% (70% for the Light's criteria). CONCLUSIONS: LDH ratio is the best individual parameter for distinguishing pleural transudates and exudates. The additional evaluation of cholesterol ratio and of the diuretic state of the patient make possible to improve the clinical efficiency of this classification. The quantification of high molecular weight proteins, acute phase reactants and citokines does not contribute additional significant information.
Subject(s)
Pleurisy/metabolism , Pleurisy/physiopathology , Adult , Biochemistry/methods , Exudates and Transudates/chemistry , Exudates and Transudates/metabolism , Female , Humans , Male , Pleurisy/diagnosis , ROC CurveABSTRACT
Indirect immunofluorescence was used to study the levels of humoral antibodies to capsid (VCA) and early (EA) antigens of Epstein-Barr virus (EBV) in sera of 322 normal subjects living in the province of Habana and varying in ages from several months to 93 years. The results suggest that the population of Cuba, like in other countries, is widely infected with EBV, although the pattern of spread of this infection has some specific features. In particular, the infection rate of the pediatric population (3--4 and 5--9 years) is moderately high, 73% and 65%, respectively, whereas in adult population it is rather low (62--86%) despite the tropical location of the country. In all the age groups examined, geometric mean titers (GMT) of antibody to VCA were also lower than in comparable groups of population from other countries. The observed high GMT of VCA antibody in persons over 55 years and a considerable increase in the number of positively reacting sera and sera with high antibody titers (greater than or equal to 1 : 160) agree with the data by other workers and appear to be due to reduced immunological defence of the cellular type in elderly people. Antibody to EBV EA were found in all the age groups examined, although in a small per cent. The subjects with high antibody titers to this antigen (greater than or equal to 1 : 40) were found more frequently in the two youngest age groups (0--2 and 3--4 years) which appears to be due to large amounts of virus usually occuring in the period of primary infection. The analysis of infectious mononucleosis incidence for 5 years (1972--1976) in various age groups of Habana province population indicates a general low level of incidence. Two small peaks in 3--4 and 15--19-year groups corresponded to increased GMT values of antibody to EBV EA in these particular age groups.
Subject(s)
Antibodies, Viral/analysis , Herpesvirus 4, Human/immunology , Immunity , Adolescent , Adult , Aged , Child , Child, Preschool , Cuba , Fluorescent Antibody Technique , Humans , Infant , Infant, Newborn , Infectious Mononucleosis/immunology , Middle AgedABSTRACT
Sera from 24 patients with nasopharyngeal carcinoma (NPC) and from 60 normal subjects were examined for the presence of IgG and IgA antibody to various antigens associated with Epstein-Barr virus (EBV). The results indicate that NPC in Cuba, like in other countries, was accompanied by high titers of EBV-specific IgG antibody the levels of which differed markedly from those in normal subjects. Serological activity of the patients differed depending on the stage of the illness and its duration. Geometric mean antibody titers to the capsid antigen (VCA), D and R components of early antigen (EA) of EBV complex were higher in patients with extensive tumour process (III--IV stages) and in patients with the duration of the disease since the onset less than 3 years. Sera of the most patients contained EBV-specific IgA antibody which were practically completely absent in sera of the control subjects. Alongside with characteristic manifestations of responsiveness to EBV observed by other workers, patients with NPC in Cuba had specific features: higher antibody titers to VCA than in Caucasian subjects in the countries where this disease occurred sporadically, like in Cuba; high levels of antibody to EA, frequently exceeding those in patients with NPC from endemic zones (for instance in Chinese patients); prevalence of EBV-specific antibody to the R component of EA complex.
